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Article: Possible Consequences of a Shortage of Hydroxychloroquine for Patients with Systemic Lupus Erythematosus amid the COVID-19 Pandemic.

Peschken, Christine A

2020 Volume 47, Issue 6, Page(s) 787–790

MeSH term(s)	Betacoronavirus ; COVID-19 ; Coronavirus Infections/drug therapy ; Coronavirus Infections/epidemiology ; Female ; Humans ; Hydroxychloroquine/supply & distribution ; Hydroxychloroquine/therapeutic use ; Lupus Erythematosus, Systemic/diagnosis ; Lupus Erythematosus, Systemic/drug therapy ; Lupus Erythematosus, Systemic/epidemiology ; Male ; Pandemics/prevention & control ; Pandemics/statistics & numerical data ; Pneumonia, Viral/drug therapy ; Pneumonia, Viral/epidemiology ; Risk Assessment ; SARS-CoV-2 ; United States
Chemical Substances	Hydroxychloroquine (4QWG6N8QKH)
Keywords	covid19
Language	English
Publishing date	2020-04-08
Publishing country	Canada
Document type	Editorial ; Review
ZDB-ID	194928-7
ISSN	1499-2752 ; 0315-162X
ISSN (online)	1499-2752
ISSN	0315-162X
DOI	10.3899/jrheum.200395
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Article ; Online: Health Disparities in Systemic Lupus Erythematosus.

Peschken, Christine A

Rheumatic diseases clinics of North America

2020 Volume 46, Issue 4, Page(s) 673–683

Abstract: Systemic lupus erythematosus (SLE) is a chronic multisystem autoimmune disease characterized by autoantibody production and diverse clinical manifestations. The many complex, overlapping, and closely associated factors that influence SLE susceptibility ... ...

Abstract	Systemic lupus erythematosus (SLE) is a chronic multisystem autoimmune disease characterized by autoantibody production and diverse clinical manifestations. The many complex, overlapping, and closely associated factors that influence SLE susceptibility and outcomes include ethnic disparities, low adherence to medications, and poverty, and geography. Epigenetic mechanisms may provide the link between these environmental exposures and behaviors and the disproportionate burden of SLE seen in ethnic minorities. Attention to these modifiable social determinants of health would not only improve outcomes for vulnerable patients with SLE but likely reduce susceptibility to SLE as well through epigenetic changes.
MeSH term(s)	Ethnic Groups ; Health Status Disparities ; Humans ; Lupus Erythematosus, Systemic/epidemiology ; Lupus Erythematosus, Systemic/etiology ; Poverty ; Social Determinants of Health ; Vulnerable Populations/ethnology
Language	English
Publishing date	2020-09-09
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't ; Review
ZDB-ID	92118-x
ISSN	1558-3163 ; 0889-857X
ISSN (online)	1558-3163
ISSN	0889-857X
DOI	10.1016/j.rdc.2020.07.010
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Article: Possible Consequences of a Shortage of Hydroxychloroquine for Patients with Systemic Lupus Erythematosus amid the COVID-19 Pandemic

Peschken, Christine A

J Rheumatol

Keywords	covid19
Publisher	WHO
Document type	Article
Note	WHO #Covidence: #46795
Database	COVID19

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Article ; Online: Disparities in rheumatoid arthritis outcomes for North American Indigenous populations.

Hitchon, Carol A / ONeil, Liam / Peschken, Christine A / Robinson, David B / Fowler-Woods, Amanda / El-Gabalawy, Hani S

International journal of circumpolar health

2023 Volume 82, Issue 1, Page(s) 2166447

Abstract: Advances in rheumatoid arthritis (RA) management have significantly improved clinical outcomes of this disease; however, some Indigenous North Americans (INA) with RA have not achieved the high rates of treatment success observed in other populations. We ...

Abstract	Advances in rheumatoid arthritis (RA) management have significantly improved clinical outcomes of this disease; however, some Indigenous North Americans (INA) with RA have not achieved the high rates of treatment success observed in other populations. We review factors contributing to poor long-term outcomes for INA with RA. We conducted a narrative review of studies evaluating RA in INA supplemented with regional administrative health and clinical cohort data on clinical outcomes and health care utilisation. We discuss factors related to conducting research in INA populations including studies of RA prevention. NA with RA have a high burden of genetic and environmental predisposing risk factors that may impact disease phenotype, delayed or limited access to rheumatology care and advanced therapy. These factors may contribute to the observed increased rates of persistent synovitis, premature end-stage joint damage and mortality. Novel models of care delivery that are culturally sensitive and address challenges associated with providing speciality care to patients residing in remote communities with limited accessibility are needed. Progress in establishing respectful research partnerships with INA communities has created a foundation for ongoing initiatives to address care gaps including those aimed at RA prevention. This review highlights some of the challenges of diagnosing, treating, and ultimately perhaps preventing, RA in INA populations.
MeSH term(s)	Humans ; Arthritis, Rheumatoid/diagnosis ; Arthritis, Rheumatoid/drug therapy ; Longitudinal Studies ; Population Groups ; Indigenous Peoples ; North America
Language	English
Publishing date	2023-01-16
Publishing country	United States
Document type	Review ; Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	1386707-6
ISSN	2242-3982 ; 1239-9736
ISSN (online)	2242-3982
ISSN	1239-9736
DOI	10.1080/22423982.2023.2166447
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Article: Do Patterns of Early Disease Severity Predict Grade 12 Academic Achievement in Youths With Childhood-Onset Chronic Rheumatic Diseases?

Lim, Lily S H / Ekuma, Okechukwu / Marrie, Ruth A / Brownell, Marni / Peschken, Christine A / Hitchon, Carol A / Gerhold, Kerstin / Lix, Lisa M

The Journal of rheumatology

2023 Volume 50, Issue 9, Page(s) 1165–1172

Abstract: Objective: To test the association of early disease severity with grade 12 standards test performance in individuals with childhood-onset chronic rheumatic diseases (ChildCRDs), including juvenile arthritis and systemic autoimmune rheumatic diseases.: ...

Abstract	Objective: To test the association of early disease severity with grade 12 standards test performance in individuals with childhood-onset chronic rheumatic diseases (ChildCRDs), including juvenile arthritis and systemic autoimmune rheumatic diseases. Methods: We used linked provincial administrative data to identify patients with ChildCRDs born between 1979 and 1998 in Manitoba, Canada. Primary outcomes were Language and Arts Achievement Index (LAI) scores and Math Achievement Index (MAI) scores from grade 12 standards test results as well as enrollment data. The secondary outcome was enrollment in grade 12 by 17 years of age. Latent class trajectory analysis identified disease severity groups using physician visits following diagnosis. Multivariable linear regression tested the association of disease severity groups with LAI and MAI scores, and logistic regression tested the association of disease severity with age-appropriate enrollment, after adjusting for sociodemographic factors and psychiatric morbidities. Results: The study cohort included 541 patients, 70.1% of whom were female. A 3-class trajectory model provided the best fit; it classified 9.7% of patients as having severe disease, 54.5% as having moderate disease, and 35.8% as having mild disease. After covariate adjustment, severe disease was associated with poorer LAI and MAI scores but not with age-appropriate enrollment. Conclusion: Among patients with ChildCRDs, those with severe disease performed more poorly on grade 12 standards tests, independent of sociodemographic and psychiatric risk factors. Clinicians should work with educators and policy makers to advocate for supports to improve educational outcomes of patients with ChildCRDs.
MeSH term(s)	Humans ; Child ; Female ; Adolescent ; Male ; Academic Success ; Rheumatic Diseases/epidemiology ; Morbidity ; Achievement ; Patient Acuity
Language	English
Publishing date	2023-02-01
Publishing country	Canada
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	194928-7
ISSN	1499-2752 ; 0315-162X
ISSN (online)	1499-2752
ISSN	0315-162X
DOI	10.3899/jrheum.220656
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Article: Severe Sensory Neuronopathy in Primary Sjögren Syndrome Resulting in Charcot Arthropathy.

Nguyen, Mai / Peschken, Christine A

The Journal of rheumatology

2016 Volume 43, Issue 7, Page(s) 1449–1451

Language	English
Publishing date	2016-07
Publishing country	Canada
Document type	Letter
ZDB-ID	194928-7
ISSN	1499-2752 ; 0315-162X
ISSN (online)	1499-2752
ISSN	0315-162X
DOI	10.3899/jrheum.160137
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Article ; Online: Polypharmacy and Potentially Inappropriate Medication Use in Older Adults With Systemic Lupus Erythematosus.

Séguin, Dale Jean-Guy / Peschken, Christine A / Dolovich, Cassandra / Grymonpre, Ruby E / St John, Philip D / Tisseverasinghe, Annaliese

Arthritis care & research

2022 Volume 75, Issue 2, Page(s) 356–364

Abstract: Objective: To assess the prevalence and potential risk factors for polypharmacy and prescribing of the potentially inappropriate medications, opioids and benzodiazepines/Z-drugs, in older adults with systemic lupus erythematosus (SLE).: Methods: The ... ...

Abstract	Objective: To assess the prevalence and potential risk factors for polypharmacy and prescribing of the potentially inappropriate medications, opioids and benzodiazepines/Z-drugs, in older adults with systemic lupus erythematosus (SLE). Methods: The study population comprised adults age ≥50 years meeting American College of Rheumatology or Systemic Lupus International Collaborating Clinics classification criteria followed at a tertiary care rheumatology clinic. Information on prescriptions filled in the 4 months preceding chart review was obtained from the Manitoba Drug Program Information Network. Clinical data, including age, sex, Charlson Comorbidity Index (CCI) score, Systemic Lupus Erythematosus Disease Activity Index 2000 score, prednisone use, SLE duration, and rural residence were abstracted from electronic medical records. Logistic regression analyses were performed to assess any association between polypharmacy (using 2 definitions: ≥5 and ≥10 medications), potentially inappropriate medication use, and clinical features. Results: A total of 206 patients (mean age 62 years, 91% female, 36% rural) were included: 148 (72%) filled ≥5 medications, 71 (35%) filled ≥10 medications, 63 (31%) used benzodiazepines/Z-drugs, and 50 (24%) used opioids. Among the 77 patients age ≥65 years, 57 (74%) filled ≥5 medications, and 26 (34%) filled ≥10 medications, compared to 30% and 4%, respectively, of Manitobans age ≥65 years (National Prescription Drug Utilization Information System, 2016). The odds of polypharmacy were greater with prednisone use (adjusted odds ratio [OR] 3.70 [95% confidence interval (95% CI) 1.40-9.79] for ≥5 medications), CCI score (adjusted OR 1.62 [95% CI 1.20-2.17]), and rural residence (adjusted OR 2.05 [95% CI 1.01-4.18]). Odds of benzodiazepine/Z-drug use were increased with polypharmacy (adjusted OR 4.35 [95% CI 1.69-11.22]), and odds of opioid use were increased with polypharmacy (adjusted OR 6.75 [95% CI 1.93-23.69]) and CCI score (adjusted OR 1.29 [95% CI 1.08-1.54]). Conclusion: The prevalence of polypharmacy in this SLE cohort was higher than in the general Manitoban population. Polypharmacy is a strong marker for use of prescription benzodiazepines/Z-drugs and opioids.
MeSH term(s)	Humans ; Female ; Aged ; Middle Aged ; Male ; Potentially Inappropriate Medication List ; Polypharmacy ; Prednisone ; Analgesics, Opioid/adverse effects ; Benzodiazepines/adverse effects ; Lupus Erythematosus, Systemic/diagnosis ; Lupus Erythematosus, Systemic/drug therapy ; Lupus Erythematosus, Systemic/epidemiology
Chemical Substances	Prednisone (VB0R961HZT) ; Analgesics, Opioid ; Benzodiazepines (12794-10-4)
Language	English
Publishing date	2022-10-11
Publishing country	United States
Document type	Journal Article
ZDB-ID	645059-3
ISSN	2151-4658 ; 0893-7524 ; 2151-464X
ISSN (online)	2151-4658
ISSN	0893-7524 ; 2151-464X
DOI	10.1002/acr.24766
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Article: A Population-based Study of Grade 12 Academic Performance in Adolescents With Childhood-onset Chronic Rheumatic Diseases.

Lim, Lily S H / Ekuma, Okekchukwu / Marrie, Ruth Ann / Brownell, Marni / Peschken, Christine A / Hitchon, Carol A / Gerhold, Kerstin / Lix, Lisa Marie

The Journal of rheumatology

2021 Volume 49, Issue 3, Page(s) 299–306

Abstract: Objective: The aims of this study were (1) to compare grade 12 standardized test results of patients diagnosed with childhood-onset chronic rheumatic diseases (ChildCRD) and unaffected peers; and (2) to identify factors associated with test results of ... ...

Abstract	Objective: The aims of this study were (1) to compare grade 12 standardized test results of patients diagnosed with childhood-onset chronic rheumatic diseases (ChildCRD) and unaffected peers; and (2) to identify factors associated with test results of patients with ChildCRD and unaffected peers. Methods: This was a population-based retrospective cohort study. All patients with ChildCRD (juvenile arthritis and systemic autoimmune rheumatic diseases) from the only pediatric rheumatology center in Manitoba for birth cohorts January 1979 to December 1998 were linked to the provincial administrative databases containing records of healthcare use and education outcomes. Patients were matched by age, sex, and postal codes to their peers who did not have ChildCRD. The primary outcomes were the grade 12 Language Arts Achievement Index (LAI) and the Math Achievement Index (MAI) scores. ChildCRD, sociodemographic, and mental health factors were tested for their associations with LAI and MAI scores using multivariable linear regression. Results: Five hundred and forty-one patients with ChildCRD were matched to 2713 unaffected peers. Patients with ChildCRD had lower LAI and MAI scores compared to their peers. More patients with ChildCRD failed or did not take the language arts (51% vs 41%, Conclusion: This population-based study showed that patients with ChildCRD performed less well than their peers on grade 12 standardized testing, independent of sociodemographic and mental health comorbidities.
MeSH term(s)	Academic Performance ; Adolescent ; Child ; Cohort Studies ; Comorbidity ; Humans ; Retrospective Studies ; Rheumatic Diseases/epidemiology
Language	English
Publishing date	2021-11-01
Publishing country	Canada
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	194928-7
ISSN	1499-2752 ; 0315-162X
ISSN (online)	1499-2752
ISSN	0315-162X
DOI	10.3899/jrheum.201514
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Article ; Online: Prevalence and Incidence of Rheumatoid Arthritis in Canadian First Nations and Non-First Nations People: A Population-Based Study.

Hitchon, Carol A / Khan, Sazzadul / Elias, Brenda / Lix, Lisa M / Peschken, Christine A

Journal of clinical rheumatology : practical reports on rheumatic & musculoskeletal diseases

2019 Volume 26, Issue 5, Page(s) 169–175

Abstract: Background: The aim of this study was to determine the prevalence, incidence, and onset age at rheumatoid arthritis (RA) diagnosis in First Nations (FN) and non-FN populations in Manitoba, Canada.: Methods: Population-based administrative health ... ...

Abstract	Background: The aim of this study was to determine the prevalence, incidence, and onset age at rheumatoid arthritis (RA) diagnosis in First Nations (FN) and non-FN populations in Manitoba, Canada. Methods: Population-based administrative health records from April 1, 1995, to March 31, 2010, were accessed for all Manitobans. The FN population was identified using the Federal Indian Registry File. Crude and adjusted RA prevalence and incidence rates (adjusted for age, sex, health region of residence) were compared using Poisson regression and reported as relative rates (RRs) with 95% confidence intervals (CIs). Mean (CI) diagnosis age and physician visits were compared with Student t tests. Results: Rheumatoid arthritis crude prevalence increased between 2000 and 2010 to 0.65%; adjusted RA prevalence in females was 1.0% and in males was 0.53%. The 2009/2010 adjusted RA prevalence was higher in FN than non-FN (RR, 2.55; CI, 2.08-3.12) particularly for ages 29 to 48 years (RR, 4.52; CI, 2.71-7.56). Between 2000 and 2010, crude RA incidence decreased from 46.7/100,000 to 13.4/100,000. Adjusted RA incidence remained higher in FN than non-FN (2000-2010 RR, 2.1; CI, 1.7-2.6; p < 0.0001) particularly for ages 29 to 48 years (RR, 4.6; CI, 2.8-7.4; p < 0.0001). The FN population was younger at diagnosis than the non-FN population (mean age, 39.6 years [CI, 38.3-40.8 years] vs. 53.3 years [CI, 52.7-53.9 years]; p < 0.0001). The FN population had more physician visits but fewer rheumatology visits than the non-FN population. Conclusions: Rheumatoid arthritis prevalence is increasing, and RA incidence is decreasing in Manitoba. The FN population has a greater prevalence and incidence of RA and is younger at diagnosis than the non-FN population. When combined with fewer rheumatology visits, this significant care gap highlights the need to optimize rheumatology care delivery to the FN population.
MeSH term(s)	Adult ; Arthritis, Rheumatoid/diagnosis ; Arthritis, Rheumatoid/epidemiology ; Canada/epidemiology ; Female ; Humans ; Incidence ; Male ; Manitoba/epidemiology ; Middle Aged ; Prevalence
Language	English
Publishing date	2019-01-22
Publishing country	United States
Document type	Journal Article
ZDB-ID	1283266-2
ISSN	1536-7355 ; 1076-1608
ISSN (online)	1536-7355
ISSN	1076-1608
DOI	10.1097/RHU.0000000000001006
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Article ; Online: Predictors of Unsuccessful Hydroxychloroquine Tapering and Discontinuation: Can We Personalize Decision-Making in Systemic Lupus Erythematosus Treatment?

Almeida-Brasil, Celline C / Pineau, Christian A / Vinet, Evelyne / Hanly, John G / Peschken, Christine A / Clarke, Ann E / Fortin, Paul R / Abrahamowicz, Michal / Bernatsky, Sasha

Arthritis care & research

2022 Volume 74, Issue 7, Page(s) 1070–1078

Abstract: Objective: Hydroxychloroquine (HCQ) is a key systemic lupus erythematosus (SLE) drug, making concerns of drug shortages grave. Our objective was to evaluate factors associated with poor outcomes after HCQ taper or discontinuation in SLE.: Methods: We ...

Abstract	Objective: Hydroxychloroquine (HCQ) is a key systemic lupus erythematosus (SLE) drug, making concerns of drug shortages grave. Our objective was to evaluate factors associated with poor outcomes after HCQ taper or discontinuation in SLE. Methods: We studied 5 Canadian SLE cohorts between 1999 and 2019, following patients from the date of HCQ tapering (cohort 1) or discontinuation (cohort 2). A composite outcome was defined as any of the following: a need for therapy augmentation, an increase (of at least 4 points) in the Systemic Lupus Erythematosus Disease Activity Index 2000 score, or hospitalization for SLE. In each cohort, multivariable Cox regression was used to identify demographic and clinical factors associated with time to the earliest of these events. A third cohort continuing to receive HCQ was also studied, to assess whether the same factors influenced the outcome even when the HCQ dose was unchanged. Results: The poor outcome rate, per 100 person-years, was 35.7 (95% confidence interval [95% CI] 31.6-40.3) in the HCQ taper cohort (n = 398), 29.0 (95% CI 25.5-33.0) in the discontinuation cohort (n = 395), and 16.1 (95% CI 13.2-19.6) in the maintenance cohort (n = 395). In patients tapering HCQ, baseline prednisone use was independently associated with greater risk of poor outcomes. In the discontinuation cohort, the risk of poor outcomes was greater for Black patients and those diagnosed with SLE at age ≤25 years. Among those maintaining HCQ, baseline immunosuppressive use and First Nations ethnicity were associated with poor outcomes. Conclusion: We identified demographic and clinical factors associated with poor outcomes after HCQ taper/discontinuation. This information is critical in the current setting of potential shortages, but over the long term, such information could inform personalized therapies.
MeSH term(s)	Adult ; Antirheumatic Agents/adverse effects ; Canada/epidemiology ; Humans ; Hydroxychloroquine/therapeutic use ; Immunosuppressive Agents/adverse effects ; Lupus Erythematosus, Systemic/complications ; Lupus Erythematosus, Systemic/diagnosis ; Lupus Erythematosus, Systemic/drug therapy
Chemical Substances	Antirheumatic Agents ; Immunosuppressive Agents ; Hydroxychloroquine (4QWG6N8QKH)
Language	English
Publishing date	2022-04-13
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	645059-3
ISSN	2151-4658 ; 0893-7524 ; 2151-464X
ISSN (online)	2151-4658
ISSN	0893-7524 ; 2151-464X
DOI	10.1002/acr.24548
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